The classification of fournier gangrene severity uses the Fournier's Gangrene Severity Index (FGSI). Mortality in Fournier's gangrene is most independently predicted by which clinical factor?
- A Extent of skin necrosis at presentation
- B Patient age alone
- C Time from symptom onset to first surgical debridement (delay >24 hours doubling mortality) ✓
- D Polymicrobial culture result versus monomicrobial infection
Explanation
Fournier's gangrene (necrotising fasciitis of the perineum/genitalia) has mortality rates of 20–40%. The FGSI uses 9 physiological parameters (analogous to APACHE II). However, the most consistently identified independent predictor of mortality across multiple studies is time-to-surgery delay — every hour of delay beyond 24 hours significantly increases mortality. The cornerstone of treatment is emergency wide surgical debridement with at least 1 cm margins into bleeding, viable tissue, often repeated, combined with broad-spectrum antibiotics and intensive care. Colostomy may be needed for rectal involvement.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.